DR. JENNIFER GENTRY
HEALTH CARE SERVICES / FINANCIAL CONTRACT
Welcome to the office of Dr. Jennifer Gentry. This document contains all the important information about our professional services, business and financial practices. Please read it carefully and ask any questions you have about the information. You will be asked to sign a separate document regarding having read this document.
Naturopathic medicine requires an active effort on your part, and in order to be successful, you will need to be willing to make certain lifestyle, behavioral, and/or dietary changes. Naturopathic Medicine takes a comprehensive approach to wellness, focusing on the body, mind, and spirit. Naturopathic medicine can be very effective in treating both acute and chronic illness and is considered preventative in nature. Your initial visit is an information gathering session that allows Dr. Jennifer Gentry to better evaluate your health care needs and then choose appropriate therapeutic treatments. If you have any questions or concerns, please let the doctor know at your initial visit, so they may be addressed immediately.
Naturopathic Medicine: A Naturopathic physician is trained as a general family practitioner. Naturopathic physicians combine modern laboratory and physical diagnostic tools with natural, nontoxic therapies that encourage the body’s inherent healing abilities. Some of the treatments may include nutrition, herbal medicine, homeopathy, counseling, chiropractic manipulation, physiotherapy, electrotherapy, natural supplementation, and other natural remedies.
Acupuncture and Traditional Chinese Medicine: Acupuncture is a five thousand year old medical tradition based on clinical observation and treatment. Diagnosis in Traditional Chinese Medicine and Acupuncture is based on observation, interview, pulse and tongue diagnosis, and other tools. Following an assessment, treatment may involve acupuncture, cupping, moxabustion, electrotherapy, bleeding, massage, and manipulation, TDP heat lamp, or other traditional treatments. Acupuncture involves the placement of sterile one-time use disposable needles into specific points on the body.
Homeopathy
Homeopathy is a system of medicine based on the Law of Similars that was founded over 200 years ago by Samuel Hahnemann, MD (1755-1843). A homeopathic remedy is an FDA approved medicine that consists of a very dilute substance. When given to someone who is healthy, a homeopathic remedy can bring about the same symptoms it can cure. When given to someone suffering from those symptoms, the body is stimulated to heal on its own and the symptoms resolve. Hence, the name, the Law of Similars, or like cures like. There are no side effects when using homeopathic remedies and no interactions to worry about. These remedies are safe to use on the youngest and most elderly patients.
Western and Traditional Chinese Herbal Medicine: Herbal medicine is based on clinical and laboratory research, as well as hundreds of years of folk medicine to address specific therapeutic goals. Herbal medicine may be prescribed as a tincture, capsule, tea, or solid extract for oral supplemental, or for topical or rectal application. Other forms of herbal treatments include aromatherapy and flower essences.
The right plan for you may be a combination of these therapies, which can be addressed, in your first visit.
HEALTH CARE SERVICES CONTRACT
Experience and Training of our Physician
Dr. Jennifer Gentry, N.M.D. is a Naturopathic Physician. Naturopathic medicine is an emerging field that incorporates the training and knowledge of conventional medicine with a holistic, natural treatment paradigm. Naturopathic physicians, like other doctors, complete a four-year undergraduate degree, followed by a four-year doctorate of medicine in a school accredited by the board of education. Therapeutic modalities include homeopathy, botanical medicine, clinical nutrition, hydrotherapy, acupuncture, physical medicine, and counseling. Using these methods, Naturopathic physicians are able to work with patients to restore health from the inside out safely and effectively, avoiding or limiting the use of harmful drugs and invasive surgeries.
Dr. Jennifer Gentry, N.M.D. attended Southwest College of Naturopathic Medicine in Tempe, Arizona and hold active medical licenses with the state of Arizona.
Patient Rights
· You have the right to be treated with courtesy, respect and dignity.
· You have the right to know the process through which services are offered, including the general course of treatment, and with whom you will be working.
· You have the right to full confidentiality. All transactions and records within this office are kept strictly confidential. Your records may be released only when requested in writing by you, or when required by law.
· You have access and may request copies of your information at any time.
· You have the right to request that the physician not make notes in the chart pertaining to sensitive matters.
· You have the right to know and understand the practitioner’s assessments and recommendations. These will be given to you at each visit including therapeutic goals, success of treatment, and proposed duration of treatment. If this is unclear please ask.
· If a medication is prescribed, or any other specific treatment is recommended, you have the right to know what the medication or treatment is, why it is being prescribed, what is the expected outcome, and the reasonable expected general side effects.
· You have the right to access other community services and also the right to select and change practitioners. If you are interested in other practitioners or therapeutic modalities please ask.
· You have the right to refuse service.
· You have the right to assert your rights as described within this document at any time without retaliation or fear of negative consequence.
· You as a patient have the right to full knowledge of fees.
· You have the right to know of any changes to services or charges and you will be notified.
HEALTH CARE SERVICES CONTRACT
Financial Policy
Office Fees:
· Our fees are based on insurance requirements that use time and complexity of your condition to determine a fair and appropriate fee for your visit. Times listed are estimates only. The typical first visit is a full hour. The typical follow up appointment lasts 30 minutes.
· Please remember, payment is expected at the time of your visit.
· Medicare and AHCCCS are not billable by our office.
· Prices are subject to change as our costs change.
New Patient / Fee / Return Patient / FeeMinor Complexity- 15 min
Low complexity- 30 min
Moderate Complexity- 1 hr (Average Visit)
High complexity- 1 hr + / $150
$250
$275
$325 / Minor Complexity- 10 min
Minor Complexity- 15 min (Acute Visit)
Low complexity- 30 min (Average Visit)
Moderate Complexity- 45 min
High complexity- 1 hr + / $35
$55
$75
$95
$125+
Common Additional Charges:
Acupuncture with a visit $10 supply fee (Plus cost of visit, above)
Acupuncture only-as a follow up $55
Spinal-Manipulation Only $30-50 (Without visit, Free as part of visit)
Hydrotherapy $25-$200
Injection/IV Therapies: Call for pricing, varies depending request.
hCG weight loss Call for pricing.
Blood Draw Fee $10, we do not bill insurance for this fee.
Lab Fees Vary by lab, Call for pricing.
Supplements and Medications Variable according to the supplement
· Additional fees may apply accordingly, but will always be expressed before treatment.
· Prices are subject to change as our overhead costs change.
· We have an extensive medicinary with herbal therapy, vitamin, and homeopathic formulas, however, if there is a supplement that you need that we do not currently stock, we will happily order a supply for you. Payment is requested in advance for specialty orders.
· We will ship supplements to your home at your request, we us USPS flat rate shipping. We charge based on the size of the box being shipped.
· Supplements may also be purchased directly from our supplier for direct mail to your home. : www.npscript.com/drjennifergentry Access Code drjennifergentry
Patient Signature (or Parent or Legal Guardian):and Date:HEALTH CARE SERVICES CONTRACT
Financial Policy
Appointments
We consider an appointment to be an agreement between you and our office. When you schedule an appointment, we reserve that time exclusively for you. We are responsible to be here and provide our services, or to inform you otherwise. You are responsible for keeping the appointment or giving us 24 hours notice of cancellation. Unavoidable emergencies will be considered reasonable exceptions.
If you miss an appointment without notifying us, you are responsible for the entire appointment fee $60.
If you cancel with less than 24 hours notice, you will be responsible for a $30 fee.
Refund and Return Policy
· Services rendered are non refundable.
· Any unopened regularly stocked item may be returned in its original condition within 30 days of purchase for a 100 % refund. After 30 days from the purchase date there is a restocking fee of 15% that will be assessed prior to the refund.
· Special orders are not refundable.
· Any returned item must have a minimum expiration date of 60 days from the return date, where applicable.
· Customized items, such as compounded supplements, tinctures, homeopathic formulas are non-refundable.
Payment
In order for us to keep our services available to our patients, it is necessary to require payment at the time of your visit. Calvo Naturopathic is not a provider for Medicare, Medicaid or any other insurance carrier. Therefore, payment is requested at the time of service and/or when products are purchased. We will provide you with complementary billing if you have other medical insurance that reimburses you for Naturopathic care. We will provide you with invoices for reimbursement from Health Savings Accounts or for tax purposes at the end of every visit.
Please remember that you are responsible for the total charge for each visit, regardless of whether your insurance company reimburses you or not.
Please pay for all medicines and supplements at the time that you pick them up, unless other specific arrangements have been made.
Balances older than 60 days are subject to additional billing fees of $20 per statement.
There is a $25 fee for returned checks.
If you would like to apply for a special payment plan due to financial hardship, please discuss this with our office manager or your doctor before your appointment is scheduled.
Family discounts are available.
There is a free 15 minute consult is available to all new patients. After 15 minutes there is a minimum charge of $30.
Patient Signature (or Parent or Legal Guardian):and Date:Page 3 of 4
Health Service Contract
Revised 3-2015; Effective 10/1/2017